Cardiovascular Diseases Epidemiology and Management in the Elderly and very Elderly.

The aim of this narrative review is to focus on the epidemiology and new advances in the management of cardiovascular diseases (CVD) in the elderly and very elderly, with particular emphasis on those CVD that are most relevant and have the greatest impact on morbidity and mortality, such as heart failure (HF), ischaemic heart disease, atrial fibrillation (AF) and stroke, valvular heart diseases and cardiomyopathies (CMP). The review highlight the specificities of CVD in this population and the special considerations that need to be made in the management of these patients to maximise benefit and avoid futility. Another major objective is to find a contemporary definition of the elderly, including functional capacity and the concept of vascular, biological and prospective age. A final aim is to review and discuss the definition and measurement of frailty and its impact on CVD management. The key points are that old and very old people are a peculiar growing population across the globe, in which CVD have a different impact and epidemiology compared to young people. Among CVD, HF is clearly the most relevant and impactful on quantity and quality of life. Each time we approach an elderly patient, a frailty multidisciplinary evaluation should be conducted, especially to avoid futile and aggressive invasive approaches with a risk-benefit balance in favor of harm.